Healthcare Provider Details

I. General information

NPI: 1649934647
Provider Name (Legal Business Name): VINCENT YEUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1242 LIBERTY AVE
BROOKLYN NY
11208-9099
US

IV. Provider business mailing address

15011 CENTREVILLE ST
OZONE PARK NY
11417-2932
US

V. Phone/Fax

Practice location:
  • Phone: 929-258-3119
  • Fax:
Mailing address:
  • Phone: 718-415-1193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number068521
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: